Department of Health and Social Care

Care Quality Commission Thematic Review of Restrictive Practices, Seclusion and Segregation

baroness blackwood of north oxford: My Hon. Friend the Minister of State for Care (Caroline Dinenage MP) has made the following written statement:The Government has made improving the care and treatment of autistic people and people with a learning disability a priority. Society is rightly judged on the way it treats its most vulnerable citizens.In November 2018, the Secretary of State for Health and Social Care made a statement to the House of Commons following the reporting of the case of Bethany, a young autistic woman who was held in seclusion in hospital for too long.Like everyone across the House, I have been moved by these individual cases and personal stories. I do not believe this is just about a few individual cases where things went wrong; this is about a system. A system across health, education, social care and criminal justice that needs to change.We know there is good practice out there and excellent examples of staff working incredibly hard and supporting individuals and their families to receive the best possible care. We need to recognise and widely spread this practice so that it becomes the practice of all. However, there is variability and unacceptable practice. We must tackle this.That is why the Secretary of State for Health and Social Care charged the Care Quality Commission (CQC) with undertaking a section 48 thematic review looking at the extent to which restrictive practice is being used in the NHS. This includes the use of segregation, prolonged seclusion and all forms of restraint: physical, mechanical or chemical.We are adamant that no stone should remain unturned in identifying problems, poor practice and care which falls so far short of what we’d expect for our own family.The CQC is today publishing it’s interim report of this review, copies of which have been placed in the Library. This report makes difficult reading. It provides early findings and recommendations on the use of segregation on mental health wards for children and young people and on wards for autistic people and/or those with learning disabilities.This is an interim report and as the CQC themselves describe there is much work that remains to be done in the rest of the review. However, the Government accepts these recommendations in full and is committed to working with partners across the health, education and care system to ensure that they are implemented.It is absolutely essential that we take all necessary actions to learn from the issues raised in this interim report:We will ensure each and every case of seclusion and long term segregation is thoroughly scrutinised and that every element of their care has been reviewed. We are clear that every possible step must be taken to ensure people get the care, support and treatment they need. We will ensure that they have access to specialist independent advocacy to support them and their families.The model of care for autistic people and those with learning disabilities must be fit for purpose – we will convene an expert group for learning disabilities and autism, bringing together leading experts, including those from other countries, clinicians, academics, parents and carers and others, to develop a new care model taking the very best practice as the foundation.We will strengthen safeguards, addressing the lack of join up across the reviews of care that people receive and working the Care Quality Commission to bolster the oversight arrangements for hospitals that use segregation.We will empower specialist advocates to raise concerns when they know something is not right. We will also develop a new awareness raising campaign, to encourage staff, families and friends to come forward if they have concerns about care.Honourable members will be aware of the recent allegations of abuse at Whorlton Hall, in to which Durham Constabulary are now leading a criminal investigation.These allegations of abuse have been treated with the utmost seriousness. Steps have been taken to ensure the safety of residents at Whorlton Hall.Where people – staff, family and friends – have concerns about any service they must raise them.We will ensure that we continue to make progress across the board on fostering a just and open culture around safety and raising concerns in the NHS.We need to improve the quality of concerns handling and ensure that this is true for every patient. Working with the Health Ombudsman we will deliver a single vision for improving how the NHS responds when concerns or complaints are raised, whether concerns are raised by patients, families, advocates or staff.The National Guardian and the local network of Freedom to Speak Up Guardians are playing a crucial role across the country in providing safe avenues for staff to raise concerns within their own organisations. We will make it even easier for people to raise concerns about patient safety in the NHS by introducing a new digital reporting system.Where it is essential that someone is supported at distance from home, we will make sure that those arrangements are adequately supervised. We cannot have people out of sight and out of mind. That is why we are introducing stronger oversight arrangements. Where someone with a learning disability or an autistic person is an inpatient out of area they will be visited every 6 weeks if they are a child and every 8 weeks if they are an adult, on site. The host Clinical Commissioning Group will also be given new responsibilities to oversee and monitor the quality of care.But we must be clear: improving the quality of specialist inpatient care is critical. But we are committed to stopping people from going into crisis and being admitted into specialist inpatient care in the first place.For example, we know that autistic children often have a range of needs. They require support from education, health and social care. We must strengthen this join up. That is why we are reviewing our autism strategy and will be extending it to include children.We must ensure autistic children get the right support they need - at the right time – and as close to home as possible. By making our strategy all age we will look at how earlier intervention can stop escalating needs.We know that autistic children and those with learning disabilities and their families can face difficulties when transitioning from child to adult services. We will continue to improve community services to support people appropriately from childhood into adulthood.As part of the implementation of the NHS’s Long Term Plan there will be concerted effort in implementing arrangements to ensure that those at the highest risk of admission to a specialist hospital or other institutional setting are getting the help they need. We will ensure that every area has such ‘dynamic support registers’ in place.We think all staff in every setting should have improved awareness of learning disability and autism. That’s why, in the coming months, we will be setting out our response to our consultation on proposals to introduce mandatory training for all health and care staff.We will continue to bring down inpatient numbers. We will take every step to take hold of the very best practice going on across the health and care system and make that the norm everywhere. There is no room for complacency.


This statement has also been made in the House of Commons: 
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NHS Accountability Framework

baroness blackwood of north oxford: My Hon. Friend the Minister of State for Health (Stephen Hammond MP) has made the following written statement:I will today lay before Parliament the Government's 2019-20 accountability framework with NHS England and NHS Improvement. For the first time, this combines the Government’s annual statutory mandate to NHS England with the annual remit set for NHS Improvement.NHS England oversees the commissioning of health services in England and NHS Improvement oversees and holds to account NHS foundation trusts, NHS trusts, and independent providers of NHS-funded care. Working together they will play a vital role in leading the NHS as it takes forward its Long Term Plan, which has been created in partnership with doctors, nurses, other clinicians and builds on the views and insights of patients and the public. They have come together under a joint senior leadership team to do this effectively and the Government is supporting them with a funding settlement that will see the NHS’s annual budget increase by £33.9 billion by 2023-24, the largest cash settlement in the history of the NHS.This is an important year for the NHS as it transitions into full implementation of the NHS Long Term Plan whilst at the same time ensuring that every patient in England will continue to receive vital services as the country leaves the EU. To put it beyond doubt that these are the most important things that the NHS has to deliver this year, the Accountability Framework sets NHS England and NHS Improvement two objectives for 2019-20: to ensure the effective delivery of the Long Term Plan, and to support the Government in managing the effects of EU Exit on health and care.The Framework clearly demonstrates the Government’s commitment to NHS staff, to the public, to patients and to taxpayers, that the Long Term Plan will be delivered and that the safety and quality of NHS services will be safeguarded through a period of change. As required by the Act, NHS England and Healthwatch England have been consulted on the objectives set in it, along with NHS Improvement.NHS England and NHS Improvement are co-ordinating a system-wide process of implementation planning, at both local and national level. This will culminate in a national implementation programme for the Long Term Plan to 2023-24, and an NHS workforce implementation plan, by the end of 2019. My intention is then to set a further Accountability Framework from 2020-21 to 2023-24 taking account of these, the outcome of our Spending Review, the needs of patients and the public, and the views of Government.As in previous years, I will also today re-lay the mandate for 2018-19. This is to take account of in-year revisions to NHS England’s budget for 2018-19. There are no other changes.


This statement has also been made in the House of Commons: 
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The third annual report of the Learning Disabilities Mortality Review Programme

baroness blackwood of north oxford: My Hon. Friend the Minister of State for Care (Caroline Dinenage MP) has made the following written statement:I am announcing today the publication of the third annual report of the Learning Disabilities Mortality Review Programme (LeDeR). A copy has been deposited in the Libraries of both Houses.The LeDeR programme was established in June 2015 to help reduce early deaths and health inequalities for people with a learning disability by supporting local areas in England to review the deaths of people with a learning disability and to ensure that the learning from these reviews lead to improved health and care services. The programme is led by the University of Bristol and commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England.It finds that the quality of care offered to people with a learning disability sometimes falls short of the standards we expect. The existence of LeDeR programme testifies to our commitment to ensure that people with learning disabilities can access the best possible quality care and support.Since the second LeDeR report was published in May 2018 the Government and its system partners have continued to make progress to implement the recommendations in that report.To support delivery of the LeDeR programme in 2018/19, NHS England allocated an additional £1.4m to support local areas to better establish their review programmes and reduce the backlog of reviews.In November 2018, I wrote to health and social care employers to remind them of their statutory obligations in terms of staff training. We have also consulted on introducing mandatory learning disability and autism training to ensure that staff across health and social care have the right skills and knowledge to provide better support and will announce our next steps following analysis of the responses.Work also continues on the inclusion of a digital flag in the records of people with a learning disability and autism to share information across health and care organisations and in the NHS Long-Term Plan we have committed to implementing this by 2023/24.NHS England have also today published its Action from Learning Report, which highlights the considerable work underway which will have a positive impact on the safety and quality of care to reduce early deaths and health inequalities.The third annual LeDeR report covers the period 1 July 2016 – 31 December 2018, with a particular focus on deaths in 2018. From 1 July 2016 – 31 December 2018, 4,302 ‘in-scope’ deaths were notified to the LeDeR programme. The majority of these (2,926) were notified in 2018. In seventy-one of the cases reviewed, people received care that fell so far short of expected good practice that it significantly impacted on their well-being or directly contributed to their cause of death.Based on the evidence from completed LeDeR reviews, the Report makes twelve recommendations for the education, health and care system which include:Support for CCGs to ensure the timely completion of mortality reviewsSupport to recognise deteriorating health in people with learning disabilitiesCare co-ordinationTransition planning for young peopleI am particularly concerned at the evidence the review presents of occasional poor practice in doctors giving the fact that a person has a learning disability or Down’s syndrome, as a rationale for a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) order. To address this, the NHS medical director has written to senior doctors and nurses, the British Medical Association and the medical Royal Colleges to ensure that doctors are reminded that a patient having a learning disability can never be an acceptable reason for a DNACPR and that they must avoid this form of discrimination. People with a learning disability have the same right to enjoy a meaningful life as anyone.While the increase in the number of reviews carried out is welcome, we acknowledge that the pace with which reviews are conducted needs to increase. I am pleased that NHS England have today announced a further £5m to speed up reviews to ensure that they are carried out as quickly and as thoroughly as possible.It is essential that we take all necessary actions to learn from the issues raised in the LeDeR report. We will consider the report and its recommendations in the coming weeks and consider the recommendations in due course.


This statement has also been made in the House of Commons: 
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Ministry of Defence

Legal Protections and Support for Armed Forces Personnel and Veterans

earl howe: My right hon. Friend the Secretary of State for Defence (Penny Mordaunt) has made the following Written Ministerial Statement.We all owe a huge debt of gratitude to our Armed Forces, who perform exceptional feats in incredibly difficult circumstances to protect this country. We set the highest standards of personal behaviour and conduct for our personnel, and rightly hold them to account when they fall short of these expectations. Service personnel must comply with Service Law (which includes the requirement to comply with the criminal law of England and Wales) whenever they are on operations, regardless of where those operations take place. This Government is strongly opposed to our Service personnel and veterans being subject to repeated investigations in connection with historical operations many years after the events in question and wants not to repeat the type of situation that has evolved under the Iraq Historical Allegations Team (IHAT). Our veterans, many now elderly and frail, face the considerable trauma of being subject to drawn-out investigations – even when ultimately there is no case to answer – and the threat of potential prosecution. This does not serve justice and the prospect of vexatious allegations has the potential to limit operational effectiveness. To address the basic unfairness of repeated investigations many years after the event, I intend to undertake a short public consultation on measures which I believe should be taken forward in legislation. One of the measures this consultation will include is a statutory presumption against prosecution of current or former personnel for alleged offences committed outside the UK in the course of duty more than 10 years previously, and which have been the subject of a previous investigation. This is not the same as a statute of limitations or amnesty, but it will mean that prosecutions in such circumstances should not be considered to be in the public interest, except in "exceptional circumstances". Our obligations to veterans who have served in Northern Ireland remain the same as those who served in other theatres. I have agreed with the Northern Ireland Secretary that my Department will provide formal input to any process taken forward by the Northern Ireland Office resulting from the Stormont House Agreement. I understand the importance of making sure this process is fair and has the trust of all sides, supporting the commitments of the UK and Irish governments to the Belfast Agreement and to peace in Northern Ireland. In this spirit, we intend to share our considerable experience of the practical difficulties of investigating historical allegations from Iraq and Afghanistan and the unintended consequences that resulted from it, and the impact this has had on Armed Forces personnel. Veterans’ voices need to continue to be heard and the lessons of IHAT need to be learned. IHAT was established with the best of intentions but was hijacked by unscrupulous lawyers who argued for an expansion of our investigative obligations. It spiralled from a two-year investigation into around 100 allegations to more than 3,500 allegations. Public Interest Lawyers – which closed in 2016 and whose principal, Phil Shiner was subsequently struck off – repeatedly argued in court both for an increase in the number of cases that should be investigated and that investigations were taking too long. Between 2014 and 2016, this firm alone notified the MOD of allegations – of unlawful killing or ill-treatment – by around 1,200 people. Of the many thousands of allegations put to IHAT, only a small proportion merited full investigation and only a handful might lead to a prosecution. There are many cases where the investigation found evidence that UK service personnel had acted in self-defence, in the defence of others, and lawfully. In some cases, allegations appear to have been completely fabricated. In an operational context, I also want to remind the House of the announcement made by the Government in October 2016 that we intend to derogate from the European Convention on Human Rights before we embark on significant future military operations, where this is appropriate in the precise circumstances of the operation in question. Any derogation would need to be justified and could only be made from certain Articles of the Convention. In the event of such a derogation, our Armed Forces will continue to operate to the highest standards and be subject to the rule of law. I have instructed my Department to work across government on how derogation might apply in the different possible circumstances of future conflicts. In relation to providing improved support, I am committed to delivering better compensation for those injured, or the families of those killed on combat operations, by bringing forward legislation as soon as parliamentary time allows. This would seek to establish a no-fault scheme that will pay the same level of compensation as a court would award. This will be of considerable benefit to Service personnel and their families, who will no longer have to pursue lengthy and stressful claims in the court. I also intend looking again at possible options which would prevent civil claims being brought in respect of historical events overseas. I will keep this House informed as we move forward with these proposals.

Ministry of Justice

Protecting Children and Parents from risk of harm in child arrangements cases in the family courts

lord keen of elie: My honourable friend the Parliamentary Under-Secretary of State for Justice (Paul Maynard) has made the following Written Statement."I wish to announce to the House the establishment of an expert panel to gather evidence on outcomes for children and parent victims in contact cases and other private law children proceedings, in particular any harm caused during or following such proceedings, where there are allegations and/or other evidence of domestic abuse or other crimes relevant to such a risk of harm.The Government takes these matters extremely seriously and wants to understand the full range of available evidence on this issue.The panel will gather evidence on the operation of Practice Direction 12J in the family courts, which sets out what the court should do in child arrangements cases where there are allegations, admissions, or evidence that domestic abuse has happened, or evidence of a risk that it could happen, to the child or another party. The panel will also consider the operation of this Practice Direction with the risk of harm exception to the presumption of parental involvement.The panel will also gather evidence of effects on children and parents/guardians in proceedings in which a parent or other person seeking contact or residence arrangements is alleged to have or has committed domestic abuse or other offences relevant to a risk of harm to a child or parent/guardian. Such other offences may include, but are not limited to, abuse of a child, assaults, sexual assault, murder or other violent crime.The Government is also aware of the potential for multiple and repeat court applications to coerce and frustrate victim parents. Therefore, lastly the panel will also gather evidence on the handling of repeat applications within the family justice system and the use of barring orders under section 91(14) of the Children Act 1989.The membership of the panel will be drawn from academia, third sector organisations, the judiciary and officials from the Ministry of Justice. I will ask the panel to conduct a Call for Evidence and report within three months of its establishment. This will enable the Government to take, as a matter of urgency, evidence-based decisions about whether and what changes are necessary to current protections."


This statement has also been made in the House of Commons: 
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Ministry of Housing, Communities and Local Government

Grenfell update

lord bourne of aberystwyth: My Rt Hon. Friend, the Secretary of State for Ministry of Housing, Communities and Local Government (James Brokenshire), has today made the following Written Ministerial Statement.I am today laying a Departmental Minute to advise that the Ministry of Housing, Communities and Local Government (MHCLG) has received approval from Her Majesty’s Treasury for a contingent liability associated with the government taking ownership of the Grenfell Tower site.The government has always been committed to working with the community to create a fitting memorial, with the Prime Minister giving her personal commitment that the bereaved, survivors and community will decide what happens to the long term future of the Grenfell Tower site.I made a commitment in August 2018 that the government would take responsibility for the Grenfell Tower site until the community has determined the long term future of the site. As part of this process, the government has also committed to transferring the land to the bereaved and survivors if that is their wish, once an appropriate body has been established.The Departmental Minute describes the contingent liability that MHCLG will hold as a result of the government owning the site.The unquantifiable contingent liability will remain for the duration of the government’s ownership of the site. The government will own the site until the community has determined the long term future use, and an appropriate body has been established, which I am advised could take up to five years.If the liability is called against MHCLG, provision for any payment will be sought through the normal Supply procedure.


This statement has also been made in the House of Commons: 
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Department for Digital, Culture, Media and Sport

Education, Youth, Culture and Sport Council

lord ashton of hyde: My Right Honourable Friend the Secretary of State for Digital, Culture, Media and Sport (Rt Hon Jeremy Wright) has made the following Written Statement:The Education, Youth, Culture and Sport (EYCS) Council will take place in Brussels on 22 and 23 May 2019. The UK’s Deputy Permanent Representative to the EU, Katrina Williams, will represent the UK for the Youth session on 22 May. Minister of State for School Standards Nick Gibb of the Department for Education will be representing the UK in the Education session. The Parliamentary Under Secretary of State for the Department of Digital, Culture, Media and Sport, Lord Ashton, will be representing the UK on 23 May for the Culture/Audio-visual and Sports Sessions. YouthThis session will begin with the adoption of the Council Conclusions on young people and the future of work. Furthermore, the Council will also seek to adopt a Resolution on the Governance of the EU Youth Dialogue. Also tabled for this session is a policy debate on young people as agents of democracy in the EU. OtherThere will be information from the European Commission in regards to DiscoverEU and information from the Portuguese Delegation on the World Conference of Ministers responsible for Youth 2019 and Youth Forum Lisboa (22 and 23 June 2019). Culture/Audio-visualThis meeting will begin with the adoption of the Council Conclusions on young creative generations. In addition, the meeting will also look to adopt Conclusions on co-productions. This shall be followed with a policy debate on ‘from tackling disinformation to rebuilding EU citizens’ trust in the media’. OtherInformation will be provided from the Hungarian Delegation on the nomination of Veszprém for the European Capital of Culture 2023. Moreover, information will also be provided from the Spanish and Portuguese Delegation on celebrating the fifth centenary of the first circumnavigation of the world, led by Fernão de Magalhães and Juan Sebastián Elcano. SportThe sport session of EYCS will begin with the adoption of a Resolution on EU Member States’ representation and coordination for the World Anti-Doping Agency (WADA) meeting in Montreal. In addition, there will also be the adoption of the Council Conclusions on access to sport for persons with disabilities. The session shall then proceed with a policy debate on increasing the participation of children and young people in sport in 21st century Europe. OtherThere will be information from the EU Member States’ representatives in the World Anti- Doping Agency (WADA) Foundation Board on the meeting with the WADA taking place in Montreal on the 14-16th May 2019. There will also be information from the Finnish Presidency on the work programme of the incoming Presidency and information from the Danish Delegation about the Council of Europe Convention on the Manipulation of Sports Competitions (match fixing) and the ways forward for the EU. To conclude, there will be information from the Bulgarian, Greek and Romanian Delegations on the signing of a Memorandum of Understanding between Bulgaria, Greece, Romania and Serbia to host either the Euro 2028 championship or the 2030 World Cup.

Department for Exiting the European Union

General Affairs Council, May 2019

lord callanan: I will attend the General Affairs Council in Brussels on 21 May 2019 to represent the UK. Until we leave the European Union, we remain committed to fulfilling our rights and obligations as a full Member State and continue to act in good faith.The provisional agenda includes:Multiannual Financial Framework 2021 - 2027Ministers and the Commission will discuss progress on the Multiannual Financial Framework (MFF) negotiations. The intention is to reach an agreement on the negotiations in autumn 2019.Preparation of the European Council on 20-21 June 2019: Annotated Draft AgendaThe Council will discuss the draft agenda for the June European Council. The agenda is expected to comprise: the adoption of the 2019-2024 Strategic Agenda for the European Union, MFF, Climate Change, the European Semester, and the disinformation and elections report prepared by the Romanian Presidency in cooperation with the European Commission and the High Representative of the Union for Foreign Affairs and Security Policy. The Presidency will also provide Ministers with an update on progress in implementing previous European Council conclusions.